Impact of Septal Myocardial Infarction on Outcomes After Surgical Ventricular Restoration

Nishant D. Patel, Lois U. Nwakanma, Eric S. Weiss, Jason A. Williams, John Conte

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background: Surgical ventricular restoration (SVR) is classically performed in heart failure patients with anteroseptal infarction. It is unknown how the extent of septal myocardial infarction (SMI) affects prognosis. We reviewed our experience to evaluate the impact of the extent of SMI on outcomes after SVR. Methods: We retrospectively reviewed SVR patients from January 2002 to December 2005. Patients were stratified based on the extent of SMI assessed by magnetic resonance imaging and intraoperative findings; SMI was graded as less than 50%, 50% to 74%, and 75% or greater of the length or height, or both, of the septum. Follow-up was 100%. Results: Seventy-eight patients underwent SVR. Twenty-eight patients had less than 50%, 30 patients had 50% to 74%, and 20 patients had 75% or greater involvement of the length or height, or both, of the septum. Patients with 75% or greater involvement had a significantly lower ejection fraction and larger left ventricular volumes preoperatively by magnetic resonance imaging. All patients with 75% or greater involvement were New York Heart Association (NYHA) class III/IV preoperatively, and 50% (10 of 20) had significant mitral regurgitation requiring a concomitant mitral valve procedure. Operative mortality was similar between groups. Cardiac function improved and was similar among the three groups postoperatively. The PR intervals on electrocardiography were similar among the three groups, but did show trends toward longer duration for those with more extensive SMI. Preoperative mean QRS duration was significantly longer for patients with 75% or greater SMI. Three-year Kaplan-Meier survival was also similar among groups; 75% or greater involvement was not a predictor of mortality on Cox regression (odds ratio = 1.4; 95% confidence interval: 0.3 to 7.0; p = 0.6). Three quarters (15 of 20) of patients with 75% or greater involvement of the septum improved to NYHA class I/II at follow-up. Conclusions: This study has evaluated the impact of the extent of SMI on SVR outcomes. These data demonstrate similar survival and significant functional and clinical improvement after SVR regardless of the extent of SMI.

Original languageEnglish (US)
Pages (from-to)135-146
Number of pages12
JournalAnnals of Thoracic Surgery
Volume85
Issue number1
DOIs
StatePublished - Jan 1 2008

Fingerprint

Myocardial Infarction
Magnetic Resonance Imaging
Survival
Mortality
Mitral Valve Insufficiency
Mitral Valve
Infarction
Electrocardiography
Heart Failure
Odds Ratio
Confidence Intervals

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Patel, Nishant D. ; Nwakanma, Lois U. ; Weiss, Eric S. ; Williams, Jason A. ; Conte, John. / Impact of Septal Myocardial Infarction on Outcomes After Surgical Ventricular Restoration. In: Annals of Thoracic Surgery. 2008 ; Vol. 85, No. 1. pp. 135-146.
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abstract = "Background: Surgical ventricular restoration (SVR) is classically performed in heart failure patients with anteroseptal infarction. It is unknown how the extent of septal myocardial infarction (SMI) affects prognosis. We reviewed our experience to evaluate the impact of the extent of SMI on outcomes after SVR. Methods: We retrospectively reviewed SVR patients from January 2002 to December 2005. Patients were stratified based on the extent of SMI assessed by magnetic resonance imaging and intraoperative findings; SMI was graded as less than 50{\%}, 50{\%} to 74{\%}, and 75{\%} or greater of the length or height, or both, of the septum. Follow-up was 100{\%}. Results: Seventy-eight patients underwent SVR. Twenty-eight patients had less than 50{\%}, 30 patients had 50{\%} to 74{\%}, and 20 patients had 75{\%} or greater involvement of the length or height, or both, of the septum. Patients with 75{\%} or greater involvement had a significantly lower ejection fraction and larger left ventricular volumes preoperatively by magnetic resonance imaging. All patients with 75{\%} or greater involvement were New York Heart Association (NYHA) class III/IV preoperatively, and 50{\%} (10 of 20) had significant mitral regurgitation requiring a concomitant mitral valve procedure. Operative mortality was similar between groups. Cardiac function improved and was similar among the three groups postoperatively. The PR intervals on electrocardiography were similar among the three groups, but did show trends toward longer duration for those with more extensive SMI. Preoperative mean QRS duration was significantly longer for patients with 75{\%} or greater SMI. Three-year Kaplan-Meier survival was also similar among groups; 75{\%} or greater involvement was not a predictor of mortality on Cox regression (odds ratio = 1.4; 95{\%} confidence interval: 0.3 to 7.0; p = 0.6). Three quarters (15 of 20) of patients with 75{\%} or greater involvement of the septum improved to NYHA class I/II at follow-up. Conclusions: This study has evaluated the impact of the extent of SMI on SVR outcomes. These data demonstrate similar survival and significant functional and clinical improvement after SVR regardless of the extent of SMI.",
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Impact of Septal Myocardial Infarction on Outcomes After Surgical Ventricular Restoration. / Patel, Nishant D.; Nwakanma, Lois U.; Weiss, Eric S.; Williams, Jason A.; Conte, John.

In: Annals of Thoracic Surgery, Vol. 85, No. 1, 01.01.2008, p. 135-146.

Research output: Contribution to journalArticle

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T1 - Impact of Septal Myocardial Infarction on Outcomes After Surgical Ventricular Restoration

AU - Patel, Nishant D.

AU - Nwakanma, Lois U.

AU - Weiss, Eric S.

AU - Williams, Jason A.

AU - Conte, John

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N2 - Background: Surgical ventricular restoration (SVR) is classically performed in heart failure patients with anteroseptal infarction. It is unknown how the extent of septal myocardial infarction (SMI) affects prognosis. We reviewed our experience to evaluate the impact of the extent of SMI on outcomes after SVR. Methods: We retrospectively reviewed SVR patients from January 2002 to December 2005. Patients were stratified based on the extent of SMI assessed by magnetic resonance imaging and intraoperative findings; SMI was graded as less than 50%, 50% to 74%, and 75% or greater of the length or height, or both, of the septum. Follow-up was 100%. Results: Seventy-eight patients underwent SVR. Twenty-eight patients had less than 50%, 30 patients had 50% to 74%, and 20 patients had 75% or greater involvement of the length or height, or both, of the septum. Patients with 75% or greater involvement had a significantly lower ejection fraction and larger left ventricular volumes preoperatively by magnetic resonance imaging. All patients with 75% or greater involvement were New York Heart Association (NYHA) class III/IV preoperatively, and 50% (10 of 20) had significant mitral regurgitation requiring a concomitant mitral valve procedure. Operative mortality was similar between groups. Cardiac function improved and was similar among the three groups postoperatively. The PR intervals on electrocardiography were similar among the three groups, but did show trends toward longer duration for those with more extensive SMI. Preoperative mean QRS duration was significantly longer for patients with 75% or greater SMI. Three-year Kaplan-Meier survival was also similar among groups; 75% or greater involvement was not a predictor of mortality on Cox regression (odds ratio = 1.4; 95% confidence interval: 0.3 to 7.0; p = 0.6). Three quarters (15 of 20) of patients with 75% or greater involvement of the septum improved to NYHA class I/II at follow-up. Conclusions: This study has evaluated the impact of the extent of SMI on SVR outcomes. These data demonstrate similar survival and significant functional and clinical improvement after SVR regardless of the extent of SMI.

AB - Background: Surgical ventricular restoration (SVR) is classically performed in heart failure patients with anteroseptal infarction. It is unknown how the extent of septal myocardial infarction (SMI) affects prognosis. We reviewed our experience to evaluate the impact of the extent of SMI on outcomes after SVR. Methods: We retrospectively reviewed SVR patients from January 2002 to December 2005. Patients were stratified based on the extent of SMI assessed by magnetic resonance imaging and intraoperative findings; SMI was graded as less than 50%, 50% to 74%, and 75% or greater of the length or height, or both, of the septum. Follow-up was 100%. Results: Seventy-eight patients underwent SVR. Twenty-eight patients had less than 50%, 30 patients had 50% to 74%, and 20 patients had 75% or greater involvement of the length or height, or both, of the septum. Patients with 75% or greater involvement had a significantly lower ejection fraction and larger left ventricular volumes preoperatively by magnetic resonance imaging. All patients with 75% or greater involvement were New York Heart Association (NYHA) class III/IV preoperatively, and 50% (10 of 20) had significant mitral regurgitation requiring a concomitant mitral valve procedure. Operative mortality was similar between groups. Cardiac function improved and was similar among the three groups postoperatively. The PR intervals on electrocardiography were similar among the three groups, but did show trends toward longer duration for those with more extensive SMI. Preoperative mean QRS duration was significantly longer for patients with 75% or greater SMI. Three-year Kaplan-Meier survival was also similar among groups; 75% or greater involvement was not a predictor of mortality on Cox regression (odds ratio = 1.4; 95% confidence interval: 0.3 to 7.0; p = 0.6). Three quarters (15 of 20) of patients with 75% or greater involvement of the septum improved to NYHA class I/II at follow-up. Conclusions: This study has evaluated the impact of the extent of SMI on SVR outcomes. These data demonstrate similar survival and significant functional and clinical improvement after SVR regardless of the extent of SMI.

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